| NPI | 1922261973 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0221X Dentist Pediatric Dentistry (Licence: GA DN013749) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 8647) |
| 1223P0221X Dentist Pediatric Dentistry (Licence: SC 735PD) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2011-04-18 |